Consensus and Controversy in Medical Practice: The Dilemma of the Critically Ill Patient

In response to the problems of coping with chronic disease, physicians are moving toward a social defini tion of life, that is, towards defining an individual as being alive if he is capable of performing his social roles, rather than if he simply meets physical criteria for life. A study of how physicians in four medical specialties say they would treat different types of critically ill patients shows that there is considerable consensus among physicians about the treatment of salvageable patients with physical damage and unsalvageable patients with mental damage but little consensus concerning those who are mentally damaged but salvageable or physically damaged and unsalvageable. Over 70 percent of the respondents in each specialty indicated that they would accept irreversible cessation of brain func tion as a criterion for death, permitting them to cease main taining the patient's respiratory functions. Examination of hospital records showed that physicians tend to overestimate on the questionnaires their likelihood of treating critically ill patients. In other words, there may be more consensus about not treating certain types of patients than the questionnaires suggest. The lack of consensus on these matters in other social institutions, such as law and religion, is also discussed.